MEDICINE, WARFARE, AND HISTORY — FULTON 431 



cide then known, had been introduced and was used by the Eighth 

 Army under tlie direction of General Fox and General Hume to delouse 

 the population of Naples and other points of southern Italy. This 

 practically abolished the typhus hazard among our occupation forces 

 and the Italian civilians. 



It would be difficult to enumerate all the special branches of medicine 

 that have benefited by war research, but there is nothing so striking 

 as the protection a Horded our troops by mass inoculation, particularly 

 against tetanus. To quote Brig. Gen. Elliott C. Cutler, chief consultant 

 in surgery of the European theater of operations in World War II, 



I would like to speak of the miracle which has occurred in eliminating tetanus 

 from military surgery. Let me recall some figures for you. In our Civil War, 

 the mortality rate was from 89 to 95 percent. Shortly before World War I, under 

 the benefit of antitoxin which was discovered and elaborated upon by the use 

 of animals, the mortality rate had dropped to between 40 and 80 percent. During 

 World War I, large statistical evidence showed a mortality rate of 20 to 58 

 percent ; but, in this second World War, there were only 11 cases known to have 

 occurred amongst 10,700,000 men. Of these 11 cases, 5 had been given toxoid 

 and 6 had not. Moreover, in these 11 cases, there are records of only four deaths, 

 two of which occurred in individuals who had received the basic series of toxoid 

 but no booster dose, and two in individuals who had not received even the basic 

 series. This is, in my mind, one of the great miracles of modern medicine. The 

 basis of the establishment of a proper toxoid rests squarely upon animal investiga- 

 tion, and no greater debt could be acknowledged to oiu' friends in the animal 

 kingdom than this advance for the good of humanity.' 



In World War I many other lessons were learned, particularly the 

 importance of moving casualties rapidly from the front lines, before 

 infection had set in. The mortality incidence from battle casualties 

 was far less than in the Civil War or the Spanish- American War, but 

 it was still high as compared with the mortality rate from casualties 

 in World War 11. 



Harvey Gushing took the lead in dealing with head wounds, and, 

 while he worked slowly, much to the consternation of other Allied 

 surgeons, he took the rugged view that one wound well handled served 

 a better purpose than a dozen hastily repaired wounds, since in nearly 

 all the latter cases the patients would die anyway. Plis paper pub- 

 lished in the British Journal of Surgery in 1918 ^ is still a classic of 

 war-time cranial surgery and has been widely quoted by Hugh Cairns, 

 Eldridgo Campbell, and others who dealt with battle casualties in 

 World War II. 



* Cutler, E. C, Military surgery — United States Army — European Theater of 

 Operations, 1944-1945 (Hunterian Lecture), Surg., Gynec. and Obst., vol. 82, p. 

 261 (March), 1946. 



* Cushing, H., A study of a series of wounds involving the brain and its envelop- 

 ing structures, Brit. Journ. Surg., vol. 5, p. 558, (April) 1918. 



